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Disorders in the immune status of patients with hypothyroidism (idiopathic and postoperative) produce a negative effect on a course of disease. Periods of decompensation (exacerbation) develop in such patients more frequently than in patients suffering from hypothyroidism with the normally or moderately changed immune status.
Altogether 44 patients with amyloidosis (7 with primary, 24 with secondary and 13 with hereditary associated with periodic disease) and different stages of renal impairment and 32 patients with chronic glomerulonephritis (CGN) (14 with the latent and 18 with the nephrotic form) were examined for chemotactic properties of peripheral blood leukocytes and skin fibroblasts in Boyden's chambers. Chemotaxis of leukocytes from patients with different clinical forms of amyloidosis was found to be decreased. That decrease manifested itself even at the proteinuric stage of renal impairment. Addition of autologous serum brought about another decrease of the chemotactic response of leukocytes. There was a lowering of chemotaxis of cultivated skin fibroblasts from amyloidosis patients, which remained unchanged on repeated cell passages. Chemotactic activity of cultivated fibroblasts from CGN patients did not differ from that of healthy persons' fibroblasts and embryonal fibroblast strain. Possible causes of the alterations revealed are discussed.
Significant advances in the treatment of tuberculosis have occurred with the introduction of short-course therapy using isoniazid and rifampin throughout therapy. The addition of pyrazinamide to the initial phase of therapy permits shortening of the total duration of treatment to 6 months for most patients. This regimen is well tolerated, results in rapid disappearance of bacilli from the sputum, and has a low rate of relapse. Ethambutol should be added to this regimen for any patient with an increased chance of having isoniazid resistant disease. Periodic culturing of the sputum from patients with pulmonary tuberculosis is essential for monitoring response to therapy. Patient noncompliance with therapy is the most common cause of treatment failure, and any patient suspected of being noncompliant should receive directly observed therapy. For this purpose, most treatment regimens may be adapted to twice weekly administration.
Thirty two patients with hematologic malignancies and solid tumors were treated with intensive therapy and autologous bone marrow transplantation. In nine out of 32 patients, it took more than 50 days to achieve a sustained platelet count of 50,000/microliter or greater. Significant associations with poor platelet recovery were found for patient age, diseases, period of cryopreservation, the kinds of eradicative therapy and in vitro purging. But most of these factors overlapped each other in the same patients. No correlation was found between platelet recovery and number of cells or CFU-GM infused.
The study comprised 70,796 litters in 104 sow herds, observed from 1976 through 1982. Weaning age decreased from approx. 42 days to approx. 30 days during the observation period. Diseases and symptoms were recorded together with production parameters (feeding, barn construction, economic returns etc.). The mean incidence rate of pre-weaning diarrhoea was 6.8% of litters, with considerable inter-herd differences (incidence rates from 0 to approx. 50%). There was a slight increase in incidence during the autumn (August through October). Incidence rates increased with litter size, with a peak incidence in litters of 11-13 piglets, and decreased with increasing parity of the sow. There was a positive association between occurrence of arthritis and pre-weaning diarrhoea in the litters, and litters from sows with post parturient disease (MMA complex) had 1.8 times higher risk of getting diarrhoea than litters from healthy sows. No important differences among breeds were found. Small herds (less than 200 farrowings per year) had higher incidence rates than large herds (400-499 farrowings per year). Herds with a gilt proportion above 30% had an incidence rate of 12.3%, i.e. nearly twice as high as the overall mean (6.8%). There was a trend towards a higher incidence rate in litters kept in traditional pens (i.e. large pens with solid floor and loose sows) than in intensive pens (i.e. small pens with slatted flooring and tethered sows). The overall pre-weaning mortality rate was 16.2% of pigs born, half of which was due to stillbirths (6.3%) and overlaid piglets (2.2%). In litters with pre-weaning diarrhoea, the mortality rate was 19%, compared to 13% in litters without occurrence of diarrhoea. This difference accounts for an excess loss of 0.6 piglets from birth to weaning in diarrhoeic vs. non-diarrhoeic litters. Piglets from litters with pre-weaning diarrhoea had reduced weight gain. Thus, on the average, they were 2.2 days older at 25 kg bodyweight and weighed 0.4 kg less at 30 days than piglets from non-diarrhoeic litters. Also, litters with pre-weaning diarrhoea had a significantly increased risk of post-weaning diarrhoea. The present information forms a basis for defining acceptable disease thresholds in suckling litters in intensively managed herds.
The activity of peripheral blood leukocyte enzymes (neutrophils and lymphocytes) was assessed by cytochemical methods in 166 patients with chronic glomerulonephritis, lupus nephritis and amyloidosis (primary, secondary, hereditary in periodical disease) to determine their importance for differential diagnosis and to assess the activity and prognosis of these nephropathies. Correlation of the nature of enzymatic shifts with nephropathy type, activity of inflammation and prognosis of nephritides was shown. The effectiveness of the use of cytochemical tests in examination of nephrological patients was substantiated.
The assessment of bone mineral mass during growth, periods diseases or therapy which modify bone mineralization in the child is of great interest. Single-photon absorptiometry carried out on forearm bones informs on the mineral density of the compact bone of the appendicular skeleton. It is easy to perform in children and infants. Dual-photon absorptiometry appears to be the most accurate for measuring bone mineral content in endocrine and metabolic bone disorders. The low dose of radiation and the non-invasive nature of this high-precision method render it well-adapted and suitable for measuring bone mineralization in childhood.
A 49-year-old nursery school teacher noticed epigastric discomfort and loss of appetite, and was hospitalized for diagnosis and treatment on Dec. 19, 1984. She was diagnosed to have Borrmann type 4 gastric cancer with Schnitzler's metastasis. After one month's administration of UFTM-O (UFT, mitomycin C, OK-432) subjective symptoms disappeared and improvement of the gastric lesion was demonstrated 2 months later. On Apr. 4, 1985 she was able to return to work, receiving UFTM-O therapy for one year as an outpatient. When ascites appeared in October, UFTM-O was discontinued and a single intraperitoneal administration of cis-platinum was done for peritoneal effusion. Another combination chemotherapy consisting of MTX, 5-FU and OK-432 was started, but she died 3 months later. In consequence, she had been able to live 18 months from the initial diagnosis. Moreover, she was able to enjoy a high quality of life, which meant she was able to return to her work and travel abroad, during the initial two-thirds of the disease period.
UNLABELLED: In order to avoid other antibiotics which interfere with plasma and CSF level determination of a given antibiotic the authors use a chemical method of established specificity. 15 patients presenting with purulent meningitis were given a standard daily dose of metampicillin and divided into 3 groups of 5. On days 2, 4 and 6 after onset of disease plasma and CSF specimens were taken at respectively 1, 2 or 4 hours following metampicillin I.V. injection according to patient group. All patients were cured between days 7 and 21 of therapy. Tolerance was good. RESULTS: --there was no correlation between dose injected and plasma level of drug,--CSF distribution of metampicillin was good and stayed identical throughout the disease period,--peak CSF drug level was delayed as compared to plasma level, occurring more than 4 hours after I.V. injection of metampicillin.
The Muckle and Well's syndrome corresponding to a transmission of the autosomic dominant type, combines bouts of urticaria, episodes of arthralgias to a shrinking of the ear and a sensory deafness. Sometimes, it evolves into a renal amylosis. Sometimes, as the case presented here, it combines multiple malformations. Its place in nosology is imprecise. It is, at the same time, close to systemic urticaria, sensory deafness, amylosis and specially amylosis of the periodic disease. But the common link between the various elements of the syndrome remains undetermined, for the time being.
Myocardial infarction accompanied by acute and chronic stress produces appreciable changes in the neuropsychic sphere during all the disease periods. The authors briefly characterize the basic clinical manifestations of the central nervous system injury in patients with myocardial infarction and provide the results of evaluating the efficacy of neurotropic agents used for correcting the psychoemotional disturbances, sleep disorders and psychological alterations. It is recommended that at the hospital and posthospital stages the tranquilizers may be combined with autotraining.
The development of synovitis was studied in 64 rabbits with experimentally produced allergic arthritis and in 30 rabbits with experimentally produced non-allergic arthritis. The results are compared with the morphological changes of the synovial membrane in rheumatoid arthritis, especially in early stages, known from the literature. The experimentally produced non-allergic arthritis shows no similarity whatsoever to rheumatoid arthritis. On the other hand, there is a pronounced similarity of the synovitis in experimentally produced allergic arthritis and in the fully developed stage of rheumatoid arthritis. In experimental allergic arthritis this stage is already reached after three weeks while the changes in the synovial membrane in rheumatoid arthritis are only little characteristic over a disease period of up to six months. A subdivision of individual morphological criteria shows special differences in the vascular changes and in the ratio of lymphocytes to plasma cells. In experimentally produced allergic arthritis, there is only initially a thrombovasculitis within the frame of the Arthus reaction whereas in rheumatoid arthritis, especially in the early stages, a proliferative vasculitis is frequently described. Furthermore, in experimentally produced allergic arthritis as compared to rheumatoid arthritis, the plasma cells are preponderating over the lymphocytes, which points to an increased humoral immune response in the animal model.
The authors report the results of the clinical, cytochemical, cytogenetic and kinetic studies (3H-thymidine autoradiography and scanning integrating cytospectrophotometry of DNA) in a male patient with chronic myeloleukemia with blast infiltration of the lymph nodes. Analysis of the karyotype and kinetic aspects of leukemic cells obtained from the blood, bone marrow, spleen and hyperplastic lymph nodes was performed over time at different disease periods. Based on the data obtained the authors suggest that aneuploid blasts may maturate before segmented granulocytes. The probability of the medullary origin of aneuploid clones is discussed.
Most cases of familial mediterranean fever (periodic disease) begin in childhood. However reports of this disorder in the pediatric literature are rare. This diagnosis is too often missed in pediatric practice. His symptomatology is the same as in adulthood with some particularities. Familial history is often the corner-stone of the diagnosis. Assessment of C'4 fraction of complement seems of good help for the diagnosis. The frequent occurrence of premonitory symptoms heralding the attacks allows us in many cases to start an intermittent colchicine therapy. Long term colchicine therapy should be used very cautiously in children and should be restricted to those children whose activities are disrupted by crisis occurring without alarm or to cases associated with amyloidosis.
Fatty changes in the liver were investigated and quantified in 678 consecutive autopsies. The changes were classified into four groups: no changes 46%, slight changes 43%, moderate changes 9%, severe changes 2%. A clear positive correlation was found between the degree of overweight and the degree of fatty changes in the liver. The fatty changes were found to be reversible. However, in emaciated patients with a long disease period the number of cases with pronounced fatty changes were significantly increased. No relation was found between diabetes and fatty changes in the liver. In patients more than 40 years old no correlation was found between age and the degree of fatty changes in the liver.
The data suggesting the enterosorbent influence on the activity of proteolysis inhibitors and arginase, on the fibrin-fibrinogen and fibronectin decay products content, blood serum toxin fixating activity of injured with the burns were presented. The dependence of expression of mentioned indexes changes from the trauma severity in acute burn disease period was shown. The enterosgel application promotes the lowering of dystrophic degree severity, alike the hepar and fixed macrophage system load, the investigated indexes normalization acceleration, and patients condition improvement.
The continuing morbidity of patients with vasculitis, despite the improved prognosis with aggressive therapy, underlines the need for accurate disease assessment. We have devised a clinical index of disease activity, and evaluated its use in several forms of necrotizing vasculitis. The weighted score is based on symptoms and signs in nine separate organ systems. Disease features are only scored if they are attributable to active vasculitis. The Birmingham Vasculitis Activity Score (BVAS) was compared with two other published vasculitis activity scores, with the physician's global assessment (PGA), with outcome, and with serological markers of disease activity. In a cross-sectional study of 213 consecutive patients with different forms of vasculitis, all 107 vasculitis patients who were judged completely well on clinical assessment had a BVAS score of 0. Twenty-two patients with active vasculitis prior to treatment had a median score of 7.5 (range 4-30) and 69 with active disease on treatment had a median score of 10 (1-29). Of the 12 who died, median score immediately prior to death was 20.5 (9-30). In a serial prospective study, 30 cases had documented episodes of active disease. During periods of disease activity, the median BVAS values were significantly higher than in remission (15 [range 3-32] vs. 0 [0-2], p < 0.001); the same was true for CRP values (80 [9-361] vs. 13.5 [5-68], p < 0.001). This was not true for erythrocyte sedimentation rate (ESR), haemoglobin (Hb) or von Willebrand factor (VWF).(ABSTRACT TRUNCATED AT 250 WORDS)
The authors detected impaired urinary excretion of some amino acids in 20 patients suffering from moderate hemorrhagic fever with renal syndrome. The excretory changes depended on the kind of amino acid, the disease period and renal function. The causes of the above abnormality are discussed.